AB0274 EFFECT OF RHEUMATOID ARTHRITIS ON BONE MINERAL DENSITY AND ITS RELATIONSHIP WITH INFLAMMATORY MILIEU IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: R. Sivaprasad, M. Gopalakrishnan, S. Khichar, R. Shukla, K. Shukla, M. K. Garg
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis (RA) is an inflammatory disorder, associated with significant systemic and local bone loss. Factors determining bone mineral (BM) loss in rheumatoid arthritis (RA) are important. This study aimed to determine the occurrence and predictors of low bone mineral density (BMD) in patients with RA. <h3>Objectives</h3> To estimate Bone Mineral Density in patients with Rheumatoid arthritis. To determine the frequency and risk factors for osteopenia/osteoporosis in patients with Rheumatoid arthritis. <h3>Methods</h3> We studied 102 RA patients diagnosed using ACR/EULAR 2010 at our Rheumatology clinic in Jodhpur, India from January 2021 to August 2021 after written informed consent and Ethical Committee approval. We collected the clinical, demographic, treatment history and calculated disease severity with Disease Activity Score (DAS28 CRP) and Clinical Disease Activity Index (CDAI). BMD was assessed (Dual-energy X-ray absorptiometry scanner-Hologic Corp, model no-Horizon A S/N 303237M). Serum samples for Interleukin-1 (IL-1) and Interleukin 6 (IL-6) were collected and stored at -80<sup>0</sup>C and analysed by ELISA. <h3>Results</h3> In the study population, with mean age of 46.7±12.3 years, median disease duration of 48±36 months, mean DAS28 CRP score of 4.5±1.2, mean CDAI value of 18.6±8.58 prevalence of osteopenia and osteoporosis calculated using T score were found to be 43.1% and 15.7% at left hip, 42.2% and 16.7% at lumbar spine, 18.6% and 17.6% at left forearm respectively(Table 1, Figure 1). There was significant variation in BMD across various age categories at lumbar spine (P value-0.031) and left forearm (P value &lt; 0.0001). There was statistically significant reduction in BMD with higher disease activity at hip (p value-0.019), however significance was not observed at lumbar spine and forearm. There was no significant association between BMD and CDAI. There was statistically significant difference in the lumbar spine BMD across the DAS 28 CRP &lt;3.2 and DAS 28 CRP &gt;3.2 subgroup. Lower values of BMD were observed in female patients, RF positive patients and established RA patients but these were not statistically significant. There was no association between Serum vitamin D3 levels, cumulative steroid dose, Interleukin-1 levels, Interleukin-6 levels, IL-17 levels, TNF α levels, Serum Osteoprotegerin (OPG) levels, Serum Receptor activator of nuclear factor kappa-B ligand (RANKL) levels and BMD. <h3>Conclusion</h3> Prevalence of osteopenia and osteoporosis and magnitude of bone mineral loss is significantly higher in our population compared to previous Indian studies including Sharma et al [1]. This lower BMD may be partially attributed to lower remission rates and low BMI in our study population. Hip joint appears to be particularly vulnerable to bone loss in those with higher disease activity suggesting that local effects maybe more important in bone loss. This observation is also supported by the finding that serum inflammatory markers or bone loss markers did not have a significant relationship to bone mineral density in our population. <h3>References</h3> [1] Sharma M, Dhakad U, Wakhlu A, Bhadu D, Dutta D, Das SK. Lean Mass and Disease Activity are the Best Predictors of Bone Mineral Loss in the Premenopausal Women with Rheumatoid Arthritis. Indian J Endocrinol Metab. 2018 Apr;22(2):236–43. [2] Kumar AA, Gupta K, S K, Kumar SA. Clinical Profile of Rheumatoid Arthritis Patients Reporting to a Tertiary Care Center – Data From Southwestern Part of India. Int J Contemp Med Res IJCMR [Internet]. 2019 Jun [cited 2022 Dec 18];6(6). <h3>Acknowledgements</h3> None. <h3>Disclosure of Interests</h3> None Declared.